Provider Demographics
NPI:1538140595
Name:GREENSTADT, KENNETH DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DOUGLAS
Last Name:GREENSTADT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4847
Mailing Address - Country:US
Mailing Address - Phone:310-792-6262
Mailing Address - Fax:310-792-6203
Practice Address - Street 1:3565 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4847
Practice Address - Country:US
Practice Address - Phone:310-792-6262
Practice Address - Fax:310-792-6203
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry